For two days, Ticia Vital refused doctors' pleas to allow them to amputate her festering left leg, even as the gangrene spread and the alternative became death.
But after a sleepless night filled with pain, the 19-year-old agreed - becoming one of scores of Haitians who have lost their limbs to the magnitude-7.0 earthquake that has devastated millions.
In a country where life is difficult in the best of times, the prospect of a future without an arm or leg is especially dismaying.
"What will I do? How will I manage to survive on my own with just one leg?" Vital asked, lying lethargically on a metal bed frame at Renaissance Hospital, which Cuban doctors founded for eye care in 2006 and swiftly converted to a trauma unit after last Tuesday's quake.
Doctors in the Haitian capital of Port-au-Prince say they have performed numerous amputations of hands, arms and legs. An exact count is impossible to make as overworked medical staff race to care for tens of thousands of patients overflowing hospital wards into parks and gardens.
"We have had to perform dozens of amputations, including many double amputations," said Dr. Diana Lardy of the Los Angeles-based International Medical Corps. "The problem is people haven't gotten medical care soon enough, so wounds are very infected. Some of them are coming in with bones just sticking out from the rest of the leg."
While most injuries occurred when buildings collapsed, Lardy said she also is seeing patients with gashes and other injuries caused by amateur rescuers who frantically dug survivors from rubble with whatever tools they could find.
"We have dozens and dozens of patients waiting for surgery, including dozens of amputations, and people are still coming in," said Lardy, of Madison, Wisconsin.
Ward space is short. Some buildings at the Port-au-Prince General Hospital, including two operating rooms, suffered quake damage.
Doctors performed 45 amputations at Renaissance in three days, said Dr. Olga Maria Delgado of Havana. Most were done outside on a white-tiled counter under a tin roof in the hospital gardens. She said sterility was less of an issue than usual because most of the wounds already are infected.
At first, patients refused to come inside the hospital for fear the building would collapse from aftershocks. But the operating room finally moved indoors Monday, starting with Vital's surgery.
As they passed, people held handkerchiefs to their noses against the stench of Vital's rotting leg. Flies buzzed around the sheet that covered her and settled on an exposed ankle bandage oozing puss.
"She repeatedly refused to have her leg cut," said her cousin, Chantal Felix. "But I talked her into it, and she had to accept it after the doctors told her the gangrene was spreading and that she would die."
Vital and Felix work selling secondhand shoes in the Bel Air slum, where they share a room with Felix's 11-year-old daughter.
"What will we do now?" Vital moaned. "What will we do?"
Unfortunately, her worries about the future may not matter. After the operation, with her leg cut above the knee, surgeon Dr. Frank Diaz said Vital was severely infected and suffering scepticemia.
"She's not been responding well to all the antibiotics we're giving her," he said. "I think she has a 90 percent chance of dying."